RESUMO
Proton pump inhibitors (PPIs) are among the most frequent implicated drugs in acute tubulointerstitial nephritis (ATIN), nevertheless it is important to report cases with atypical profiles. A 80-year-old female, exposed during 34 months to omeprazole, presented with polyclonal hypergammaglobulinaemia and renal failure. After stopping omeprazole there was a partial improvement in serum creatinine and IgG. Renal biopsy revealed ATIN; immunohistochemistry for IgG4 was negative. Treatment with steroids and mycophenolate sodium improved renal function and normalized immunoglobulins. The lack of data of other entities and the patient's evolution strongly point omeprazole as the culprit. After 27 months of follow-up, she remains clinical and analytically stable. ATIN caused by PPIs may appear after a long period of exposure and may be accompanied by analytical anomalies that simulate a systemic disease.
RESUMO
Several vascular abnormalities have been reported in autosomal dominant polycystic kidney disease (ADPKD). Occlusion of the renal artery is uncommon in ADPKD and can be associated with hypertension. We report a 38-year-old woman with ADPKD and severe hypertension, abdominal magnetic resonance angiogram and arteriography revealed left renal artery total occlusion. A revascularization approach was not considered feasible and she was given conservative treatment. We review the literature and make some comments about renal artery occlusion in ADPKD. This association should be kept in mind in cases of ADPKD with severe or resistant hypertension.
Assuntos
Hipertensão/etiologia , Rim Policístico Autossômico Dominante/complicações , Obstrução da Artéria Renal/diagnóstico , Adulto , Feminino , Humanos , Obstrução da Artéria Renal/complicaçõesAssuntos
Glomerulonefrite Membranosa/etiologia , Doença de Hodgkin/complicações , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Terapia Combinada , Dacarbazina/administração & dosagem , Doxorrubicina/administração & dosagem , Glomerulonefrite Membranosa/tratamento farmacológico , Glomerulonefrite Membranosa/imunologia , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/imunologia , Doença de Hodgkin/radioterapia , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/etiologia , Prednisona/uso terapêutico , Indução de Remissão , Tacrolimo/uso terapêutico , Fatores de Tempo , Vimblastina/administração & dosagemAssuntos
Edema/etiologia , Doenças dos Genitais Masculinos/etiologia , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Idoso , Edema/diagnóstico , Edema/diagnóstico por imagem , Doenças dos Genitais Masculinos/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico por imagem , Humanos , Masculino , Escroto/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Glomerulonefrite/imunologia , Imunoglobulina G , Mieloma Múltiplo/complicações , Idoso , Humanos , MasculinoAssuntos
Lúpus Eritematoso Sistêmico/complicações , Nefrose Lipoide/etiologia , Anti-Inflamatórios/uso terapêutico , Diagnóstico Diferencial , Edema/etiologia , Feminino , Humanos , Hipertensão Renal/etiologia , Imunossupressores/uso terapêutico , Nefrite Lúpica/diagnóstico , Pessoa de Meia-Idade , Nefrose Lipoide/diagnóstico , Nefrose Lipoide/tratamento farmacológico , Nefrose Lipoide/patologia , Prednisona/uso terapêuticoAssuntos
Injúria Renal Aguda/etiologia , Fluorbenzenos/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Esforço Físico , Pirimidinas/efeitos adversos , Rabdomiólise/etiologia , Sulfonamidas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Rosuvastatina CálcicaRESUMO
Mechanical complications of femoral catheterization for hemodialysis include pseudoaneurysm, arteriovenous fistulae, neurological injury, and vessel perforation. With regard to the latter, severe hemorrhage is a rare but devastating and potentially fatal complication. We report the case of a 76-year-old female who underwent femoral catheterization for hemodialysis using ultrasound guidance. The first hemodialysis session was conducted without incident. Unfortunately, inadvertent injury and delayed perforation of the iliac vein resulted in severe hemorrhage and retroperitoneal hematoma. Surgical repair was performed. The patient was asymptomatic after the procedure and was discharged 15 days later. Based on this case and a review of the literature, we present mechanisms and ways to prevent this complication.